This supplemental application (PA-18-591) is submitted in response to NOT-OD-20-097 to enhance the Southern Community Cohort Study (SCCS) data to permit evaluation of the effects of the Coronavirus Disease 2019 (COVID-19) pandemic within the SCCS, a prospective cohort study that includes primarily African American and low-income populations in the southeast US. COVID-19 has resulted in a global pandemic. The burden of these outbreaks appears to be unequally shared in the US, with reports that rates of infection or severe outcomes, including death, are more common among older adults, those with comorbidities, and African Americans. Transmission reduction is only achievable through adherence to individual infection prevention behaviors and community-level interventions, such as social distancing. As the COVID-19 pandemic is expected to last multiple months and perhaps years, there is an urgent and unmet need to understand 1) the extent of adherence to infection prevention recommendations, particularly among individuals at high risk for adverse outcomes, and 2) the factors that are associated with adherence in order to inform continued interventions for infection prevention. In addition, the same public health measures intended to reduce transmission have also resulted in record levels of unemployment, social isolation, food insecurity, and many other challenges. While these effects have been observed across multiple US populations, they also have the potential to exacerbate existing health disparities in vulnerable populations or to create new ones. The effect of the pandemic on lifestyle factors related to cancer or other chronic diseases and the general well- being of already vulnerable populations is not yet well described nor understood. Many pandemic interventions have been aimed at flattening the curve in order to reduce the potential to overburden the health care system, including the cancellation or delay of health care procedures and appointments. There are many additional potential factors which could affect access to and utilization of health care services during the COVID-19 pandemic, all of which may result from or exacerbate cancer and other health disparities within the US. Thus, the aims of this supplemental application are 1) To determine adherence to SARS-CoV-2 infection prevention and transmission reduction recommendations and individual and contextual factors that are associated with adherence; 2) To evaluate racial/ethnic, socioeconomic, geographic and urban/rural disparities in well-being and lifestyle behaviors resulting from the COVID-19 pandemic containment and mitigation efforts; and 3) To evaluate racial/ethnic, socioeconomic, geographic and urban/rural disparities in healthcare access during the COVID-19 pandemic, including access to SARS-CoV-2 testing, as well as routine and urgent clinical care. The data from this study will enable better quantification of COVID-19 pandemic effects in a diverse US population classified by race, geography, socioeconomic status, and other attributes. These findings will help to inform individual-level and community-level public health interventions during the COVID-19 pandemic.